Safeguard your child’s sight

Increased screen time contributes to dry and tired eyes

Our children are precious, and so is their eyesight. Basic vision screenings are part of pediatric health care, and primary care physicians perform these screening eye exams. They help catch developmental issues requiring a referral to a pediatric optometrist or ophthalmologist for diagnosis and treatment such as strabismus (misalignment), amblyopia (lazy eye) and anisometropia (asymmetric refractive error), as well as anatomic abnormalities like cataracts.

Primary care practices are increasingly using automated vision screeners. Children look inside these electronic boxes for a refraction and alignment test, providing data indicating whether they might require eyeglasses, patching or even surgery. This makes exams more efficient and reduces the number of unnecessary referrals.

There is no evidence that all children need full, dilated eye exams, unless there is a strong family history of vision problems or the child has subjective complaints. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) encourages the medical home (primary care practice) as the place to conduct pediatric vision screenings. Children are never too young for vision screenings. Providers can always get information, even in infants.

Screen time strain

The popularity of online videos, television shows and gaming geared to children and teens has markedly increased the amount of daily time spent in front of screens. There is no hard data indicating screen time is damaging to the eyes, but there is a decreased blink time versus when you are reading books. People tend to look away from reading material more often than they do with screens.

With much of today’s school work online, children are taking fewer breaks from screens, which is fatiguing to the eyes and contributes to dryness.

Pediatric ophthalmologists have observed an increase in strabismus among teenagers, frequently requiring surgery to correct. There is a lot of accommodation required by the eyes to concentrate on a small target, like a screen, for a prolonged period of time.

In 2019, the World Health Organization (WHO) released the first guidelines on screen time for children under the age 5. WHO recommends zero screen time for children under two years of age, and only 60 minutes (or less) each day for two- to four-year-olds.

Protection is key

Unfortunately, pediatric eye trauma is common. According to AAPOS, “Close to 50 percent of [eye] injuries occur in sports and recreational activities — more often in children and teens than any other age group.”

I have seen this first-hand. Projectile eye injuries caused by toys, rocks and debris propelled by lawn equipment and household items like pencils, scissors and cleaning solutions can be superficial to severe. Everything is an eye injury waiting to happen.

Children participating in sports, and all children with poor vision in one eye, should consider wearing eye protection featuring sports frames with shatterproof polycarbonate lenses.

Erin Salcone, MD, is a Pediatric Ophthalmologist at the Children’s Hospital at Dartmouth-Hitchcock (CHaD). For more information, go to

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